The "Magic" of Physical Therapy

Physical therapy (PT) can deliver positive thoughts into motion when summoned. One popular aspect is when the beneficial outcome surrounding a successful PT encounter is mutually celebrated by all parties involved. However, sometimes there seems to be a general disconnect on the understanding of what makes a fruitful PT experience actually successful. After speaking with several patients and the general public, it seems that there's an abundance of confusion as to what physical therapy actually is and how it tends to work its “magic.”  

Throughout my frequent long days of working in an outpatient PT facility, I often hear patients erroneously utter the words "fix me” in various ways. Poor phrases tend to circulate the clinical atmosphere such as: "I need you to fix me." "Thanks for fixing me." "You fixed me, but I managed to screw it up again." I hate to be the bearer of bad news, but love to be the presenter of truth. The truth is that the aforementioned sayings are all misnomers and highlight an unfortunate epidemic plaguing the world of physical rehabilitation. This epidemic primarily relates to passiveness of patients in their rehab process. It is a passiveness created around erroneous expectations of physical therapists and misconceptions about therapist job requirements and abilities.

Contrary to popular belief, physical therapists don't really fix people. It's not a therapist's job to fix anyone, nor do therapists possess the superhuman qualities to fix anyone. What therapists actually do is coach. What we actually are, are coaches. We are health coaches, bio-mechanic coaches, musculo-skeletal coaches that develop a patient-specific plan of care consisting of various treatment techniques and therapeutic exercise to help restore functionality. The reason why it comes off as a “fix” is because when physical therapy is performed correctly to a treatable case, it allows for the augmentation of function and reduction/elimination of symptoms. We make people feel better, but we do not fix people. We provide the tools to help people fix themselves. These tools allow patients to be active participants in their rehab process and not passive mummies that view PT to that of a spa treatment. We provide the program, we provide encouragement, we provide help. Work is required for both parties involved. That is the fix, that is the magic. However, magic only happens when each party owns up to their role in the game.

Now, it is quite true that there are many useful techniques (manual, instrument-assisted, or modality treatment) employed by a PT that seem magical but are impossible to be duplicated by a patient. Although these therapist-applied treatments are beneficial, the true magic is formed when patients follow the therapist-scripted blueprint on how to keep those results attained from whatever the PT is solely capable of providing. What may feel like a fix will be disappointingly short-lived if active participation is neglected on the patient's part. The true magic of physical therapy is centered around the human experience and not from any form of spellbinding magical PT prowess in any case. Physical therapy uses the skill of the therapist combined with the wants and needs of the patient to bring the best attainable results possible. Active engagement is 100% required for all. Physical therapy may seem magical, but only due to all the unspoken intangibles involved around when humans interact together positively. Great communication and being on the same page highlight the true magic of physical therapy. Physical therapy is individualistic. It's altruistic. It's an art.

                                        

Clifford Civil, PT, DPT

clifford@duffyandbracken.com

Practicing Mindfulness: Get to Know Your Body Better!

Life is hectic. Between our jobs, taking care of our families, pets, plants, homes, etc., there is hardly a spare moment in the day to focus on ourselves. On top of that, we live in a bustling city that makes it even more difficult to tune in to our internal processes. Thus, it’s no wonder most of us experience stress of varying degrees, negatively impacting our emotional and physical states.

Mindfulness is one way to improve stress and help our bodies function better. Through self-observation without judgment, mindfulness can enhance one’s understanding of their present-moment experience. This practice of “tuning-in” has been supported by scientific research to have physical and cognitive benefits, including reducing blood pressure1, depression2, anxiety3, chronic pain4, and enhancing our learning and memory processes5. In addition, the American Heart Association supports the use of meditation and mindfulness as a means to reduce stress and risk of cardiovascular disease.6

Approaching your physical therapy with mindfulness can maximize the benefits of therapeutic exercises and help you to better understand your body. Here are some ways to use mindfulness to optimize your rehabilitation:

1. Take a moment to pause. Use this moment to gain an understanding of the state of your body. Whether you’re sitting on the subway, at your desk, or maybe lying on the treatment table about to do some exercises, take a moment to acknowledge any sensations or emotions you are feeling. Are you holding tension in any part of your body? Can you consciously let that area relax? After a stressful meeting or exercise, how has your body responded? Establishing a connection between stress, emotion, activity, and your pain can help you gain a sense of control of how your body feels.

2. Focus on your breath. Bringing attention to the breath is a great way to tune into the body and help you to relax. To start, place one hand on your chest and the other over your navel. Take note of how they rise and fall as you breathe. Is your breath slow and steady, or restricted and tense? Do you tend to hold your breath more when you’re stressed or exercising? It’s quite common for people to hold their breath when they’re exerting themselves. Therefore, try practicing focused breathing while doing your exercises!

3. Perform exercises with intention. When performing your exercises, you should have an understanding of the area being targeted and the purpose of the exercise. For example, is the exercise helping with strength or flexibility? When you’re performing the exercise, do you feel it working the targeted area? Are you performing the activity with the proper form? If you are unsure, just ask your physical therapist. They will be more than happy to review your exercises with you!

4. Quality over quantity. As you progress through your rehab, your exercise list starts to grow and it can take a while to get through everything. You may find yourself quickly powering through those leg raises or rows because you need to get back to work or start dinner, or they may be challenging and you just want to get them over with! Unfortunately, when performing exercises faster, the tendency is to lose that sense of intention discussed above and form starts to break down. Without the proper form, you might not be optimally working the targeted area, and therefore not reaping the full benefits of the exercise. Therefore, when it comes down to it, your physical therapist would rather you maintain the quality of the exercises, even if that means you may have to reduce the quantity.

In conclusion, get to know your body! We as physical therapists are here to get the ball rolling and provide guidance, but ultimately you play the most important role in your body’s journey toward healing. Practicing mindfulness in your everyday life and applying it during your therapy will help enhance your understanding of your body and make the most out of your rehabilitation.

Hillary Keating, PT, DPT

hillary@duffyandbracken.com

References

1. Hughes, Joel W., et al. "Randomized controlled trial of mindfulness-based stress reduction for prehypertension." Psychosomatic medicine 75.8 (2013): 721-728.
2. Teasdale JD, Segal ZV, Williams JM, Ridgeway VA, Soulsby JM, Lau MA. Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Journal of Consulting and Clinical Psychology. 2000;68:615–623
3. Roemer L, Orsillo SM, Salters-Pedneault K. Efficacy of an acceptance-based behavior therapy for generalized anxiety disorder: evaluation in a randomized controlled trial.Journal of Consulting and Clinical Psychology. 2008;76:1083–1089.
4. Grossman P, Tiefenthaler-Gilmer U, Raysz A, Kesper U. Mindfulness training as an intervention for fibromyalgia: evidence of postintervention and 3-year follow-up benefits in well-being. Psychotherapy and Psychosomatics. 2007;76:226–233.
5. Hölzel, Britta K., et al. "Mindfulness practice leads to increases in regional brain gray matter density." Psychiatry Research: Neuroimaging 191.1 (2011): 36-43.
6. "Meditation and Heart Health." Meditation and Heart Health. http://www.heart.org/HEARTORG/HealthyLiving/StressManagement/TakeActiontoControlStress/Meditation-and-Heart-Health_UCM_452930_Article.jsp#.VrIReLIrJD8 . 07 Feb. 2016.

 

GRAVITYFIT

Renuka wrote an earlier blog this year called “It’s all about the curves”. Make sure you read it. I have to write this follow up blog emphasizing the important and accessible technology called Gravity Fit. This was invented by Dr. Carolyn Richardson as Australian physiotherapist and researcher, who has spent her career studying the spinal curves and how to turn on the core to support them. 

I have been a PT for 32 years now and know that “we” as a society are in BIG trouble, muscular-skeletally speaking (one thing at a time) due to our posture and poor ability to support our curves. Dr. Richardson knew this well and promised that she had something in mind to help this and it is here!  “GRAVITY FIT” 

Renuka and I have had the pleasure to study with her, learn the system and we want to share it with you.

I have been using it, as has my husband and all my friends and their children. It is a simple system and yes looks a little funny but it is based on research done by an AUTHORITY in the field. Among Dr. Richardson’s, impressive bio is the work she did with the European Space Agency, where they shared research to learn about how to help the astronauts with the problem of losing 50% of their muscle -all the core muscles -while in space. The movers remain causing imbalances and yes, pain. Well, the same thing is happening to the seated worker and slumped walker, gym goer, even athletes and definitely to our children. 

I have been quoting Carolyn for years. “ We are turning into jellyfish”! Muscular skeletal pain is at an all time high!. 

Dr. Richardson has given us the solution and we have incorporated it into our practice and have it available for anyone who wants to set up an appointment to get the system and learn how to use it. There is NOTHING else like this and I can confidently say that we don’t have a better solution. Certainly, telling people to sit up straight, does not work.

Copyright © 2016 GravityFit

Wearing the Gravity fit tools while walking, doing exercise and even while sitting at the desk can recharge your core, like recharging your cellphone and keep you injury and pain free. 

Call to reserve your Gravity Fit System and learn how to use it. 

Ann Duffy, MA, PT
Wearing Gravity Cap
212-402-5430

ViPerform Wearable Sensor Technology now available at Duffy & Bracken

The latest in wearable sensor technology is now available at 

Duffy & Bracken to measure your movement and muscle activity

At Duffy & Bracken we want to keep you safe, optimize your performance and help you recover. To do that, we need to tailor a treatment plan that's unique to you. Now we have a great tool that does just that. It’s called the dorsaVi Movement Suite and it uses revolutionary wireless wearable sensors to objectively measure exactly how you move. These are the same sensors that elite sports trainers are using with Olympians and professional athletes to measure range of motion, acceleration and muscle activity. By recording data at 200 frames per second, the dorsaVi Movement Suite provides our team with visual, objective, easily interpreted data to assess your technique and movement for performance analysis and muscle re-education.

How does it work?

The dorsaVi Movement Suite’s sensors adhere to the skin using low irritant, disposable adhesive pads. There are two different types of sensors that have tiny electronics built inside: Movement sensors and Muscle Sensors (EMG). The movement sensors are about the size of a small USB stick and can be placed on different parts of your body to record different movements to capture and quantify how you bend, twist, and move. These sensors send the data wirelessly to pager sized Recording and feedback Device (RFD) that talks to software on our computers. The system also allows us to videotape you so that we can show you what’s happening with the data when you move in a certain way.

Previously, this kind of data has only been available in expensive and sophisticated bio mechanics laboratories. Now we can offer these tests to everyone.

The dorsaVi Movement Suite can be used to do quick in-clinic assessments as well as providing immediate visual feedback for movement retraining. In addition, unlike a biomechanics lab, the dorsaVi Movement Suite also lets us monitor your movements outside the clinic. For example, the dorsaVi Movement Suite allows us to monitor you if you go for a run outside on any surface in any environment. We can tell you how you’re performing when you’re fresh or fatigued. Are you favouring one leg or the other? How do you land on one foot vs. the other?

The system can also be programmed to provide you with alerts when you move in a way that our team believes will be undesirable to you either now or later.

What can the dorsaVi Movement Suite measure?

The dorsaVi Movement Suite can be used to measure movement and muscle activity on different parts of your body, or it can be used to enhance technique or optimize performance in activities like running.

Want to learn more?

Give as a call or visit our clinic to learn more about what the dorsaVi Movement Suite can do for you. You can also find more information at dorsaVi’s website: http://us.dorsavi.com/  

It's All About the Curves!

The post-holiday season has us sporting more curves than necessary so why not start the New Year on focusing on the curve that matters the most.

While the word ‘curves’ is associated more with vanity and the fashion industry --- physical therapists are also interested in your curve --- but not the fashionable one ---the functional one.

The most important curve in your body is your ‘spinal curve” and the loss or gain of it sets you up for a lifetime of niggling and annoying pains. The stiff back on long car rides, the need to stretch your neck when staring at a computer screen, the shuffling in your seat at a movie theatre – if this sounds familiar then you have compromised your curves. It's these ignored pains that can sometimes lead to severe problems which in turn lead to major surgeries.

The human spine has 3 curves—cervical, thoracic and lumbar curve. The balance between the three curves is optimal for functioning and getting through the movements that occur in daily life. 

The cervical curve is the inquisitive curve as it allows us to move to discover our world. Functionally it supports the weight of the head (approx. 8-10lbs) and when optimally balanced allows for 180 degrees of rotation or looking over each shoulder (think backing up a car).

The thoracic curve is like the powerhouse curve as it supports the weight of both arms (approx. 15-18lbs each). Then it also supports 24 ribs that protect the heart and lungs and viscera. Then it also has to expand and contract while we breathe all this while allowing us free arm motion.

Then the lumbar curve it’s the expensive curve compensated most for increased movement and lack of strength. It costs us billions per year in medical cost. Just look at the stat below.

The prevalence of pain has a tremendous impact on business, with a recent report by the Institute of Medicine indicating that the annual value of lost productivity in 2010 dollars ranged between $297.4 billion to 335.5 billion. The value of lost productivity is based on three estimates: days of work missed (ranging from $11.6 to $12.7 billion); hours of work lost (from $95.2 to $96.5 billion); and lower wages (from $190.6 billion to $226.3 billion

But fear not….. All problems have solutions ---and so does the spinal curve!

Dr. Carolyn Richardson as Australian physiotherapist and researcher has spent her career studying the spinal curves and has proven hypothesis and theories by doing research on astronauts. I have had the pleasure to study with her and learn her system called “GRAVITY FIT” that offers real world solutions to spinal and peripheral joint pain. Learn more at www.gravityfit.com.au

No one can escape gravity but it is one of the most predictable elements in life 9.8m/s2 and it’s constant. So if you are not in a good relationship with gravity expect breakdowns in your body. Gravitational force is acting on you at all times 24/7/365. And the more your body and gravity and work together the lesser stresses on your joints, ligaments, muscles etc.

Renuka Pinto, PT, MA
renuka@duffyandbracken.com

Not As Easy To Move As It Used To Be? Think About Structural Integration

I moved to Guilford, Connecticut from Brooklyn in the fall of 2013 to get closer to air, light and water. And a less expensive, more spacious apartment was a big plus. I especially like being near the ocean. Every morning I check out the tide chart that’s posted on the refrigerator and note when high tide will hit Guilford Harbor so I can run down to Jacobs Beach for a quick swim. I’ve enjoyed learning about the tides and like the feeling of moving through my day with a little deeper connection to natural rhythms than in my Brooklyn days. Walking back from a high tide swim recently I met Bob Mahoney, an old fellow I’d often seen walking slowly across the town green. Bob shared with me that he would be going sky-diving next week to celebrate his 80th birthday. I started to suspect that he was full of the Irish blarney when he told me he had finished the New York marathon when he was 76, then four years into his battle with Parkinson’s. Later I did an Internet search for Bob and sure enough, there he was, featured in the Shoreline Times edition of June 30, 2012. Yikes, and here I am, still patting myself on the back for completing my first 5K race in April and this old guy, a number of years my senior, has done the NY marathon while facing a serious neurological condition.

And more: From a recent NY Times article detailing research on athletes competing in the Senior Games I read, “…the results were impressive. While the athletes’ average chronological age was 68, their average fitness age was 43, a remarkable 25 years less…” One of the principal researchers comments, “A majority of the athletes didn’t begin serious training until quite late in life, middle aged or older…so you can start anytime. It’s never too late.”

I don’t think I’m going to start training for the Senior Olympics (I would qualify based on age) but I’m very aware that the more I move, the better I feel and the more I’m inclined to move some more. And I’ve learned that a couple of the most pervasive causes of the stiffness and tightness we associate with aging are gravity and lack of movement. We can’t do much about gravity but we can learn how to move more easily and efficiently in it’s field. A central aspect to my practice of KMI structural integration (a first cousin to rolfing) is to help my clients find and release those stuck spots (that we might not even be conscious of) that we move around, not through. Perhaps we’re compensating for an old injury or poor postural habits or whatever accumulation of traumas that bind tissues together in search of stability. It’s a natural bandaging process that in the short run serves to relieve pain but in the longer run can fix the body in less than healthy movement patterns that may ultimately cycle into chronic pain.

The KMI series is designed to systematically make conscious those impediments to movement and unwind deep holding patterns, always inviting length and breadth and balance. Most clients will experience a sense of “feeling taller” (sometimes they actually are!) and moving more easily. Normally experienced over 12 sessions, it is “project” oriented with each session focusing on a specific goal. Such as mobilizing a stuck ribcage that restricts free breathing patterns, realigning the feet and pelvis for better support, decreasing tension in the neck and back---all in service to gaining a better relationship to gravity and posture.

So if you’re experiencing stiffness or tightness and you like the idea of “a full body tune up” give me a call at 203-809-0036 to schedule a free consultation. I am in the Duffy and Bracken office on Fridays and occasional Thursday afternoons.

RD Hunting, CMT, CST

How to get the most out of physical therapy

This may surprise you, but lately I’ve had patients that come for therapy and seem like they are just fulfilling a requirement. They have minimal questions, one word answers and frequently ask how much longer until they are better.  Maybe they have had bad experiences in the past, or have lost hope of getting better.  But with everything in life, whether its work, fitness, or relationships, we get the most out of things we put time and effort into. Physical therapy is the same.

I thought it might be helpful to give a physical therapist’s honest perspective on how you as a patient can be sure to get the most out of your physical therapy sessions. First, it’s important to want to get better, and to prepare mentally for the likelihood that it will take time and patience to get there. You should be ready to put in the time needed for appointments and a home program. Also, part of wanting to get better is being flexible and open to limiting or changing current workout regime if needed.

Secondly, ask questions! Ask why you are doing specific exercises or why your therapist is using a specific manual technique on you. This is a great way to be involved and learn about your body. After all, this is YOUR body and you only have one! You can also do your own research on the web and ask us questions about what you find.

Lastly, be honest from the start. If you can only make 3 sessions or there is no way your life can go on if you have to quit running then tell us. Open communication is a key part of a patient-therapist relationship. We can be flexible too. If you can only make 3 sessions instead of 10 sessions, there is a big difference in what your therapist might spend their time doing during your sessions.

I enjoy being a physical therapist because of the relationships I build with my patients and the opportunity it gives me to help and motivate patients. These things work so much better when patients are ready and willing to be active participants in the rehabilitation process.

Candice Amat, PT, DPT
candice@duffyandbracken.com